Joris van Dongen

28 Chapter 2 of the loss of cell-cell communications and extracellular matrix. In most of the non- enzymatic intraoperative isolation procedures the cell-cell communications remain intact, resulting in an end product with more volume (tSVF). Different studies assessed the cell yield and phenotype of the isolated cSVF or tSVF of the various intraoperative isolation procedures compared to other intraoperative (commercial) procedures or to the gold standard for SVF isolation (non-intraoperative culture lab-based collagenase protocolswhichrequire cGMPfacilities forclinical use, referred toas ‘non-intraoperative isolation protocol’). Recently, new intraoperative isolation procedures are introduced and tested. It is not clear yet if intraoperative isolation procedures generate a similar quality and quantity of SVF as non-intraoperative isolation protocols. Next to this, the distinction between end products of intraoperative isolation procedures, e.g. cSVF and tSVF have never been studied. Therefore, a systematic review was performed to assess the efficacy of intraoperative isolation procedures of human SVF based on number of cells, cell viability and composition of SVF. In addition, duration and costs of the intraoperative isolation procedures were compared. MATERIAL & METHODS Protocol and registration This study was performed using the PRISMA protocol 16 . The search strategy for this systematic reviewwas based on a Population, Intervention, Comparison, and Outcome (PICO) framework 17 . The study was not registered. Eligibility criteria Studies were included when at least two different types of intraoperative isolation procedures or one intraoperative isolation procedure with a non-intraoperative isolation protocol were assessed using human adipose tissue to isolate SVF. Studies need to use the adipose fraction of lipoaspirate. Studies only evaluating centrifugation forces, sonication or red blood cell (RBC) lysis buffer were excluded. Studies focusing on processing methods of adipose tissue for the use in fat grafting were excluded as well as case reports, case series and reviews. Searches were not limited to date, language or publication status (Table 1). Information sources and search Pubmed, EMBASE (OvidSP) and The Cochrane Central Register of controlled trials databases were searched (searched 28 th September, 2016). The search was restricted to human studies. The search terms (Table 2) were based on three components: (P)